HealthCare.gov Explorer: Decode the Health Law’s Subsidies

By Christopher Weaver

HealthCare.gov Explorer can now calculate premium subsidies and cost-sharing reductions. Explore how they stack up in 36 states using the federal marketplace.

With just over three weeks left to choose new coverage in the health law marketplaces, deciphering the complex system of subsidies remains a key challenge for many would-be insurance customers.

To help users decode the law’s new system of tax credits, The Wall Street Journal has added a calculator to its HealthCare.gov Explorer. Use the new tool here to see premiums before and after subsidies in the 36 states that rely on the federal marketplace website.

Health insurers and the Obama administration are pushing to enroll millions of uninsured Americans through the new marketplaces ahead of the March 31 deadline. After a troubled launch last fall, the administration has largely repaired the flawed HealthCare.gov website and enrollment has picked up. Congressional budget forecasters said last month that about six million people would join the exchange through the end of March, though that’s a step back from the original target of seven million.

See how federal premium subsidies and cost-sharing reductions are calculated.

New survey data released last week by the consulting firm McKinsey & Co. suggested one big reason people are shying from the new marketplaces is that they don’t think they can afford coverage and are unaware that federal subsidies may help. About 80% of people who told McKinsey they couldn’t afford coverage are eligible for subsidies. About 65% of those people didn’t know the subsidies were available, or didn’t know how much they could get, the survey found.

Tooling around the map shows the potential impact of the subsidies on premiums for insurance shoppers earning below 400% of the federal poverty level, or $45,960 for a single person.

A 55-year-old in Worth County, Ga., the most expensive county for insurance, would have to pay $804 a month for the cheapest mid-level, or silver, plan available there before subsidies. For higher-earning customers not eligible for subsidies, that price may be steeper than their coverage before the health law.

But, a person of that age earning $45,960 would get a $478-per-month subsidy, bringing the price down to $326 a month. At $20,000 a year, that person could get a $755-per-month subsidy, bringing the direct price to about $60 a month. The law uses a formula that calculates subsidies based on the difference between a set percentage of a consumer’s income and the cost of the second-cheapest silver plan available.

Additional subsidies are available on silver plans to help reign in deductibles and copays for people earning between the poverty level and 2.5 times that amount.

As of late last month, about four million people had chosen private plans in the marketplaces, according to a Department of Health and Human Services blog post. New enrollment figures are expected in the coming days—the administration has provided mid-month updates since November.

Comments (5 of 17)

"if you're not in the top 10%, the amount of $ taken from you is probably relatively small."

The 90th percentile of earnings was $144,000 in 2011. It's higher now. How much do you think people who make, say, $75,000 a year pay in taxes? Hint: it's not "relatively small" except compared to those in the upper 10%. People below the 90th percentile pay a LOT in taxes. I know - I'm one of them. And I'm not "greedy" because I don't volunteer to pay more taxes. Shame on you for suggesting otherwise.

"if you are low income you don't need to buy a new car, go out to restaurants a lot or go on vacation

Exactly who are YOU to say what "low income" people need? Most people need a car to get to work. Most people want to go out to eat every once in a while. Most people would like to take their kids on an occasional vacation.

Perhaps you are saying that if people spend their money on those things first, before taking care of essentials - such as housing, food, or medical care - why should you have to make up the difference for them? Well, that is a good question. What is your answer?

"wait till you get laid off and lose your insurance to see what it's like."

Well. So you got laid off. So did I. Three times. Each time I went out and got a better job, the last time in 2007 when I was 62 years old.

"Hope you get laid off "

Figures. Your bitterness wishes the worst on everyone else. Take a deep breath, bud. You are responsible for your own life. No one else is. What are you doing about it?

Please don't answer to me. Answer to yourself.

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